By Annie Angle, cancer nurse, Dip. Oncology Nursing, Royal Marsden, London
Reviewed by: Dr Michael Jefford MBBS, MPH, MHlthsevMt, PhD, MRACMA, FRACP
Consultant Medical Oncologist, Peter MacCallum Cancer Centre
How likely is it that my cancer will come back?
Why do doctors use five-year and 10-year survival rates?
How accurate are the statistics?
Fear of getting a different cancer
How can I check myself for signs of a new cancer?
Feeling anxious and frightened about the cancer coming back is a very common fear for cancer survivors, especially in the first year after treatment.
For some people the fear is so strong that day-to-day life is a big struggle. They don't find any joy in life or believe that they ever will again. Living with this fear has been described as a ‘shadow': no matter which way you turn, it is always there.
‘The fear is always there. It never goes away completely.' (Maria)
Many survivors say that with time their fears lessen. But they also say that no matter how much time passes, it is hard not to be reminded at certain times such as:
‘Cancer will always leave a scar. The scars are internal, they're emotional, they're intellectual, and they are physical. The physical scars are probably the least of the worries, but it's the emotional scars that people go through in terms of their journey.' (Neil)
Your cancer doctor is the best person to speak with about what symptoms you should look out for and report. They will also be able to give you some idea about the risk of your cancer coming back. But this is only if you want to know. Not everyone is ready to hear these answers as soon as their treatment finishes. You don't ever need to ask if you don't want to. Do what feels right for you.
At first you may think that every ache, pain, runny nose or feeling of sickness means that your cancer has come back. You may worry so much that you find yourself at your GP's office more than usual. Try to remember that every symptom doesn't mean that your cancer has come back. Most survivors say that over time, their confidence builds up and they don't think about their cancer coming back as much.
If you do have a symptom, try not to worry too much. If the symptom doesn't go away within a week, make an appointment to see your GP or specialist. They will be able to reassure you and decide whether or not you need to have any further tests.
Remember: a lot of symptoms won't have anything to do with your cancer. You may just have a headache, stomach upset or feel generally tired and run down from the past few months of your treatment.
You may also wish to read the section titled ‘Long-term side effects from cancer treatment'.
You may also wonder how likely it is that your cancer will come back, or how long most people who have had your type of cancer live for.
Your cancer doctor is the best person to talk with about your case. But they still won't be able to tell you for sure what will happen. You may find this very hard to accept and want someone to be able to give you definite answers. This is very natural.
How well your body deals with your cancer and its treatment won't be the same for everyone. We are all unique: for example, the same type of cancer can grow at different rates in different people.
Your doctor will be able to give you some answers based on research studies and from their experience with other patients, but there is always going to be some uncertainty. Try not to let it get you down too much. Many cancer survivors say that with time, you will find your own way of coping with the possibility of your cancer coming back.
You may hear your doctor talk about ‘five-year' or ‘10-year' survival for your type of cancer. These statistics cause a lot of confusion and concern for many people. Because of this we thought it might help to try and explain exactly what they mean.
‘Five-year survival' and ‘10-year survival' refers to the percentage of people who are living five or 10 years after their diagnosis with a certain type of cancer. For example, about 83 out of every 100 men (83%) diagnosed with prostate cancer will be alive five years after they are diagnosed. This doesn't mean that all these men are cured. But it does not mean that they will only live for five years either!
Some patients may be cured but for others their cancer will come back (recur) in this five-year period. They may have another lot of treatment and continue to live for many more years. For some patients the cancer will come back after the five years.
Generally, the more time that goes by, the less likely it is that your cancer will recur. For example, you have a much lower chance of your cancer coming back after five years than you do after two years. And the more years that you go on without your cancer coming back, the higher your chance of complete cure is. This is true for most types of cancers.
Depending on the type of cancer, there may be only a small chance that it will come back after five or 10 years. But most doctors are wary of saying that you are ‘cured' because they know that there is still that small chance. So instead they use the terms 'five-year survival' and ‘10-year survival'.
Most of the research studies that follow patients up after their cancer treatment go for five or 10 years, so these are the statistics your doctor will use and quote to you.
Five-year and 10-year cancer survival rates are very general. They include everyone with that type of cancer at all stages and grades of the disease. People treated effectively at an early stage can generally count on their survival being better than the average five-year or 10-year rate, while people treated while their cancer is at a later stage may have a slightly poorer outlook.
Remember: no statistics can tell you exactly what will happen to you. You and your cancer are unique.
Statistics take many years to collect and therefore are usually slightly out of date. For example, if you have cancer diagnosed in 2006, the five-year survival rate available may be from 2002. With cancer treatments improving all the time, your outcome is likely to be better than it would have been reported in 2002.
It may be reassuring to know that statistics such as five-year survival rates are likely to change and improve for many types of cancers in the next 20 years.
You should feel free to ask your doctor about the five-year survival rates for your type of cancer. Not everyone wants to know or feels ready to find out immediately after finishing their treatment. For some people it is only something else to worry about. So only ask if it is something you feel comfortable about knowing. You may want to wait a few months before asking or you may never want to ask.
There is no right way to feel about this. What feels right for you is right.
As well as worrying about your cancer coming back, you may also worry about developing a different cancer.
Most people who get cancer only get one primary type. It is very rare to develop another, different cancer. But, like most things in life, it is possible. Your risk may be higher if:
If you have concerns about getting a different type of cancer, it can help to talk to your doctor. They should be able to give you information specific to you and the treatment you had for your cancer.
Where appropriate you can take advantage of the national screening programs for breast, cervical and bowel cancer. These regular checks are one of the best health habits to get into.
If you are at high risk you may also be able to have tests for prostate, skin, breast, bowel and cervical cancer.
Look at our website for more information about cancer screening. You can also talk to a cancer nurse at the Cancer Council Helpline on 13 11 20.
Whilst it is important to be ‘body aware' and keep a check on any symptoms you may have, it helps not to worry too much either. For example, you may wish to get into the habit of checking your skin, breasts or testicles every month for any abnormal changes. But aim to strike that healthy balance of checking yourself regularly and not worrying too much in between.
Below is a checklist of possible signs of cancer. You should contact your doctor if you have:
Remember: this is a guide. If you have concerns about any symptoms, see your doctor.
